As we look forward to spring, the 2014 Boston Marathon is coming up right around the corner. Traditionally the Boston Marathon brings with it a sense of excitement and healthy competition. This year of course it will also be the one year anniversary of the Boston Marathon bombings. For everyone affected by this tragedy, we have included some tips below to help people deal with the anniversary.

This newsletter issue also discusses one of our newest trainings -- "Trauma and Trauma-Informed Care." Agencies, programs, and schools using trauma-informed care have found that people who were affected by trauma as well as others benefit from this approach.

I would also like to remind you that the "13th Annual Massachusetts Suicide Prevention Conference" is on

April 16-17. We will all be there, and two of our staff members will be involved in presenting workshops. It is a great opportunity to learn, share, and network. Details on the event are outlined below. I look forward to seeing you there!

Larry Berkowitz, EdD

Director, Riverside Trauma Center

Boston Marathon Bombings Anniversary

This year's Boston Marathon will be held on

April 21, 2014. With the memories of last year's Boston Marathon bombings still in our minds, many people continue to deal with lingering feelings about the tragedy as this year's event fast approaches. Here are some tips on dealing with the upcoming anniversary of the Boston Marathon bombings:

As the day comes near, expect reminders related to the anniversary. Don't be surprised if thoughts and feelings that had lessened, come up for you again. Anniversaries can often bring up the original feelings of loss, sorrow, anger, grief, and confusion.

There is no "right" way to feel. Be accepting of your own thoughts and feelings, as well as those of people around you.

At times, anticipating a particular upcoming day or event causes more anxiety than the day or event itself. You might find that the days and weeks leading up to the anniversary are more difficult than the actual anniversary day.

If you feel you might have difficulty with the day, plan out how you would like to spend that day; think of the people who you would like to spend it with.

There is no "right" way to commemorate the day. Do as much or as little as feels right to you. You can choose to participate in the public memorials, do something in private or with a small group of loved ones, or do nothing at all.

Pay attention to your media viewing on the days leading up to the anniversary and Marathon. Images and news stories can be triggering, and it might be more helpful for you to limit your viewing.

Engage in activities that bring you comfort and joy. Take time to take care of yourself. Simple things like spending time with loved ones, taking a walk, eating a healthy meal, or taking a nap might help you feel better.

Remember, there is no timeline for "getting better." Everyone heals at their own pace.

For further counseling resources or support:

Call the Disaster Distress Helpline toll free at 1-800-985-5990 or text TalkWithUs to 66746. This free service offers multilingual, confidential crisis support, 24 hours a day, 7 days a week.

Dial 2-1-1 in Massachusetts for free, 24 hours a day, 7 days a week, to find critical health and human services available in your community

Visit StayStrongBoston.org to use a free, confidential screening tool that may help you decide if a professional consultation would be helpful to you

For more resources, including this article formatted as a handout, please visit our website.

Alan (Lanny) Berman, PhD, Executive Director of the American Association of Suicidology since 1995

Craig A. Miller, author of the book This is How it Feels, attempt survivor, and motivational speaker

Riverside Trauma Center's very own Jim McCauley, LICSW, and Joanna Bridger, LICSW, will be providing workshops. Jim will be facilitating the presentation "Hitting the Ground Running," which will involve members of the New Bedford Suicide Coalition discussing how suicide prevention activities were quickly implemented throughout the city after the suicide deaths of three young teens. Joanna will present "Understanding Trauma and Trauma-Informed Care," which provides information about the prevalence and impact of traumatic events and looks at why a focus on trauma is important. It discusses trauma-informed care and what it means to be trauma informed, how this differs from and overlaps with trauma treatment, and what providers can do to make their practices/policies more trauma informed.

Riverside Trauma Center has been conducting an increasingnumber of trainings on "Understanding Trauma and Trauma-Informed Care" for a wide range of audiences, including schools, human service agencies, and the Massachusetts Department of Correction, just to name a few. Potentially traumatic events are common and there is mounting evidence that they are more common than most of us have realized. While we know that people often show striking resilience in the face of adversity, we also know that trauma can have a lasting impact on people in a broad range of ways. Trauma can affect every area of human functioning -- physical, mental, behavioral, social, and spiritual. In most cases, we will not know the full extent of what other people have experienced in regard to trauma.

Trauma-informed or trauma-sensitive care is often likened to universal precautions in health care. Universal precautions assume anyone may have a disease, and so we keep people safe by practicing sterile procedures with everybody. Similarly, if we start with the assumption that anyone may have experienced trauma, we can avoid doing further harm by treating everyone in a trauma-sensitive manner. Agencies, programs, and schools that have adopted a trauma-informed approach have found that not only the people who have been affected by trauma benefit from this practice, but everyone at every level of the organization also benefits.

For example, in her article, "Why Schools Need to be Trauma-Informed,"1 Barbara Ohlenburg talks about overall improvements in academic achievement and test scores, school climate, teacher sense of satisfaction and safety, and retention of new teachers using a trauma-informed approach to education. She also mentions that improvements in those schools involve reductions in student behavioral outbursts and referrals to the office; stress for staff and students; absences, detentions, and suspensions; student bullying and harassment; the need for special educational services/classes; and overall dropout rates. At the Baker Elementary School in Brockton, after two years of working towards becoming a trauma-informed school, office referrals were down 75% from baseline. Elizabeth Barry, the Executive Director of K-8 learning and teaching for the Brockton School District says, "That's the number I find most meaningful. When teachers are less inclined to send a child to the office, it speaks to their capacity and commitment to support all children socially, emotionally, behaviorally, and academically."2

Riverside Trauma Center's Trauma-Informed Care training provides information about the prevalence and impact of traumatic events and explains why a focus on trauma is important. The training defines what it means to be trauma informed, how this differs from and overlaps with trauma treatment, as well as what providers can do to ensure their practices/policies are more trauma informed. Joanna Bridger, LICSW, Riverside Trauma Center's Clinical Services Director, will be presenting a session on trauma-informed care at the "13th Annual Massachusetts Suicide Prevention Conference" in April.

Susan is a 27-year-old graduate student at a prestigious university. She is smart, attractive, and has many friends. Yet she struggles with an eating disorder and recently thought about suicide: "With the stress of class, work, and above all my eating disorder, I found myself completely overwhelmed and exhausted. An eating disorder is different than other addictions. You can't avoid it. You must face your addiction several times every day. The thoughts I battle are like another full-time job and it's grueling. Last week I woke up and thought how wonderful it would be to be dead. I am just so tired, even tired of breathing. Tired of everything. Dying seemed like a great solution."

Susan's articulate description of her struggle with an eating disorder opens a window into the connection between eating disorders and suicide. According to the American Association of Suicidology, one of the major causes of premature death in eating disordered patients is suicide.1 The suicide mortality rate among both anorexics and bulimics is 23 times higher than that of the general population. For anorexia, the rate of suicide is 57 times higher, making it one of the highest risk categories of any psychiatric diagnosis.

Suicide attempts are also at extremely elevated rates for this population. Studies of the lifetime prevalence of suicide attempts range as high as 26%. The majority (62%) of eating disordered patients who make a suicide attempt report more than one attempt.

Why are the rates for suicide death and attempts so much higher for the eating disordered population? Those struggling with eating disorders develop a habituation to pain through extreme exercising, starvation, and self-injury. In Why People Die by Suicide, Thomas Joiner describes how exposure to pain and self-injury leads to the acquired ability to overcome our natural self-preservation instincts.2 The eating disordered patient who contemplates suicide is much more likely to follow through on the wish to die and use more lethal methods.

Treatment for eating disorders requires a comprehensive team approach involving therapists, physicians, nutritionists, and peer support. Working with this population requires specialized training and access to more intensive treatment options, including inpatient, day treatment, and intensive outpatient programs. Clinicians need to routinely monitor eating disorder patients, especially those with comorbid disorders, for acute risk factors and suicidal ideation.

When Susan felt suicidal she immediately reached out to her support network, her therapist, and her self-help group. The suicidal crisis passed and she has resumed her recovery activities with new energy and insight.

1"Suicide and Eating Disorders," American Association of Suicidology fact sheet. Retrieved from www.suicidology.org.

Many people in the immediate aftermath of a traumatic incident will have some level of difficulty processing the event. In the majority of cases these symptoms are to be expected, and most people will eventually recover fully without significant intervention. Some people, however, will continue to struggle for a longer period of time. For those trauma survivors having difficulty, the staff at Riverside Trauma Center is always looking for new tools to facilitate people's natural adaptive processing.

One of the new tools we are using is the Recent Traumatic Episode Protocol (R-TEP)* for Eye Movement Desensitization and Reprocessing (EMDR). This is an intervention designed in Israel to help people deal with a range of traumatic events. It is a brief, more contained approach than EMDR for processing disturbing memories. The instructions given to clients interested in the R-TEP give a good picture of how it helps: "This EMDR protocol is especially suited for early intervention. Its aim is to help your natural system digest the disturbing fragments of the traumatic episode so that you can regain your balance."

In the aftermath of the Boston Marathon bombings, the Boston Area Recovery Network of the EMDR Humanitarian Assistance Program offered the R-TEP training to local clinicians who were previously trained in EMDR. Three Riverside Trauma Center staff members took advantage of the training and are now able to use this tool to help anyone impacted by a traumatic event manage intrusive images and the resulting distress.

If you are interested in learning more about the R-TEP, please contact us.

If you would like to share some comments about our newsletter or provide us with some ideas for articles that you would like to see, please send an email to tcenter@riversidecc.org. We would love to hear from you.

Riverside Trauma Center is a service of Riverside Community Care, a non-profit organization. Services are primarily funded through donations and contracts from the Massachusetts Departments of Mental Health and Public Health. All contributions are welcome and appreciated.